喹硫平治疗精神分裂症伴抑郁症状的疗效

目的 :观察喹硫平治疗精神分裂症伴抑郁的疗效 ,并与利培酮作对照。方法 :对 5 2例精神分裂症伴抑郁病人分成喹硫平组与利培酮组 ,其中喹硫平组 2 7例 ,给予喹硫平 30 0～ 70 0mg·d- 1治疗。利培酮组 2 5例 ,给予利培酮 2～ 5mg·d- 1治疗。观察时间 6wk ,采用PANSS ,HAMD ,CGI等量表 ,分别于治疗前及治疗后wk 1,2 ,4 ,6末评定疗效 ,用TESS观察不良反应。结果 :经 6wk治疗后 ,喹硫平组与利培酮组疗效比较 ,经Ridit分析 ,差异无显著意义 (P >0 .0 5 )。但HAMD评分 ,喹硫平组治疗后减分率大于利培酮组 ,差异有非常显著意义 (P <0 .0 1)。结论 :喹硫平治疗精神分裂症伴抑郁与利培酮疗效相似 ,提示喹硫平除了具有抗精神病性症状作用外 ,还可能具有情感稳定的作用     

利培酮或喹硫平与多奈哌齐联合使用对老年痴呆患者精神行为症状的治疗效果

目的 研究利培酮或者喹硫平与多奈哌齐联合使用对老年痴呆患者精神行为症状的治疗效果。方法 选择2015年1月-2017年12月许昌市第二人民医院的198例老年痴呆患者,随机分为利培酮组以及喹硫平组。利培酮组采用利培酮联合多奈哌齐治疗,喹硫平组采用喹硫平联合多奈哌齐治疗。两组治疗2个月后,比较MMSE评分、BEHAVE-AD评分以及TESS评分。结果 利培酮组与喹硫平组的有效率相比无明显差异。两组治疗后的认知功能MMSE评分均明显升高,同组治疗前后比较差异有统计学意义（P<0.05）,但两组间相比无明显差异。两组治疗后的幻觉、偏执妄想、行为紊乱、昼夜节律紊乱、攻击行为、焦虑恐惧以及情感障碍评分值均明显降低,同组治疗前后比较差异有统计学意义（P<0.05）,但两组间相比无明显差异。喹硫平组治疗1个月和2个月后的TESS评分均明显低于利培酮组,差异有统计学意义（P<0.05）。结论 利培酮或者喹硫平与多奈哌齐联合使用均可以有效改善老年痴呆患者的精神行为症状,但与利培酮相比,喹硫平的不良反应更少,更适合用于老年痴呆患者的治疗。     

Amisulpride: a review of its use in the management of schizophrenia

Amisulpride (Solian), a substituted benzamide derivative, is a second-generation antipsychotic that preferentially binds to dopamine D2/D3 receptors in limbic rather than striatal structures. High dosages preferentially antagonise postsynaptic D2/D3 receptors, resulting in reduced dopamine transmission, and low dosages preferentially block presynaptic D2/D3 receptors, resulting in enhanced dopamine transmission. Amisulpride (200-1200 mg/day) was at least as effective as haloperidol and as effective as risperidone or olanzapine, in studies of up to 1 year in patients with schizophrenia manifesting predominantly positive symptoms. Amisulpride (50-300 mg/day) was significantly more effective than placebo in studies of up to 6 months in patients manifesting predominantly negative symptoms. Quality of life was also improved significantly more in patients receiving amisulpride than in those receiving haloperidol in 4- and 12-month studies in patients with predominantly mixed symptoms. Amisulpride was generally well tolerated in clinical trials. In patients with predominantly positive symptoms, amisulpride appeared to be better tolerated than haloperidol and was tolerated as well as risperidone and olanzapine. The incidence of extrapyramidal adverse effects with amisulpride was lower than with haloperidol but was generally similar to risperidone or olanzapine. Weight gain with amisulpride was less than that with risperidone or olanzapine and, unlike these agents, amisulpride does not seem to be associated with diabetogenic effects. Plasma prolactin levels are increased during amisulpride therapy and amenorrhoea occurs in about 4% of women. The incidence of adverse events with low dosages of amisulpride (< or = 300 mg/day) in patients with predominantly negative symptoms was similar to that observed with placebo. In conclusion, oral amisulpride (200-1200 mg/day) is at least as effective as haloperidol, and as effective as risperidone or olanzapine, in the treatment of patients with schizophrenia manifesting predominantly positive symptoms. In the treatment of patients manifesting predominantly negative symptoms, low dosages of amisulpride (50-300 mg/day) are significantly more effective than placebo. Amisulpride appears to be better tolerated than haloperidol, causing a lower incidence of extrapyramidal adverse effects and an improved quality of life. Compared with risperidone or olanzapine, amisulpride is more likely to cause hyperprolactinaemia, but has a lower propensity to cause weight gain and does not seem to be associated with diabetogenic effects. Thus, amisulpride is an effective and well tolerated option for the first-line treatment of patients with acute schizophrenia as well as for those requiring long-term maintenance therapy.     

利培酮与氯氮平治疗精神分裂症比较

目的 :比较利培酮和氯氮平治疗精神分裂症的疗效和安全性。方法 :利培酮组 30例 (男性 12例 ,女性 18例 ,年龄 34a±s 10a ,BPRS评分 5 4分± 5分 )用利培酮 1～ 8mg/d ,po ,bid ;氯氮平组 30例 (男性 14例 ,女性 16例 ,年龄 33a± 11a ,BPRS评分 5 5分± 5分 )用氯氮平 5 0～ 40 0mg/d ,po ,bid ;均以BPRS ,TESS评定观察 8wk。结果 :利培酮组有效率为 83% ,氯氮平组为 80 % (P >0 .0 5 )。利培酮组对阴性症状起效较早 ,对兴奋躁动控制较差。利培酮组较多见副作用为锥体外系症状 ( 2 7% ) ,与氯氮平组 ( 3% )比较差异有显著意义 (P <0 .0 5 ) ,其他副作用较少而轻。结论 :利培酮与氯氮平疗效相似 ,适宜剂量 (≤ 4mg/d)的利培酮是一种安全有效的抗精神病药。     

Amisulpride: a review of its use in the management of schizophrenia.

Amisulpride, a substituted benzamide derivative, is a second-generation (atypical) antipsychotic. At low doses, it enhances dopaminergic neurotransmission by preferentially blocking presynaptic dopamine D2/D3 autoreceptors. At higher doses, amisupride antagonises postsynaptic dopamine D2 and D3 receptors, preferentially in the limbic system rather than the striatum, thereby reducing dopaminergic transmission. In patients with acute exacerbations of schizophrenia, the recommended dosage of amisulpride is 400 to 800 mg/day, although dosages < or =1200 mg/day may be administered. In comparative trials, amisulpride administered within this range (400 to 1200 mg/day) was as effective as haloperidol 5 to 40 mg/day, flupenthixol 25 mg/day and risperidone 8 mg/day in patients with acute exacerbations of schizophrenia with predominantly positive symptoms. Amisulpride was more effective than haloperidol but equally effective as risperidone in controlling negative symptoms. Amisulpride 400 to 800 mg/day was more effective than haloperidol, risperidone and flupenthixol in controlling affective symptoms in these patients. In randomised, double-blind trials involving patients with predominantly negative symptoms of schizophrenia, amisulpride 50 to 300 mg/day was more effective than placebo. Amisulpride is effective as maintenance therapy in patients with chronic schizophrenia. Long-term treatment with amisulpride was associated with improvements in quality of life and social functioning. Amisulpride is generally well tolerated. In well-controlled trials, the neurological tolerability profile (including ratings on extrapyramidal symptom scales) of amisulpride 400 to 1200 mg/day was superior to that of the conventional antipsychotics (haloperidol or flupenthixol), but was similar to that of the atypical antipsychotic risperidone. At low dosages of amisulpride (< or =300 mg/day), the incidence of adverse events (including extrapyramidal symptoms) reported with amisulpride was similar to that with placebo. CONCLUSION: In comparative trials, amisulpride 400 to 1200 mg/day showed efficacy in reducing overall symptomatology and positive symptoms similar to that of conventional antipsychotics and newer atypical antipsychotics in patients with acute exacerbations of schizophrenia. Moreover, its effective alleviation of negative and affective symptoms, its lower association with extrapyramidal symptoms and loss of cognitive function than conventional antipsychotics and its long-term efficacy justifies consideration of the use of higher dosages of amisulpride in this group of patients. Consequently, the dosage of amisulpride that is recommended in patients with acute exacerbations of schizophrenia is 400 to 800 mg/day, although dosages < or =1200 mg/day may be administered. Lower dosages of amisulpride (50 to 300 mg/day) should be considered for the management of patients with negative symptoms of schizophrenia. Amisulpride is a first-line treatment option in the management of schizophrenia in the acute phase and for the maintenance of treatment response.     

Spotlight on amisulpride in schizophrenia

Amisulpride, a substituted benzamide derivative, is a second-generation (atypical) antipsychotic. At low doses, it enhances dopaminergic neurotransmission by preferentially blocking presynaptic dopamine D(2)/D(3) autoreceptors. At higher doses, amisulpride antagonises postsynaptic D(2) and D(3) receptors, preferentially in the limbic system rather than the striatum, thereby reducing dopaminergic transmission. In patients with acute exacerbations of schizophrenia, the recommended dosage of amisulpride is 400 to 800 mg/day, although dosages < or = 1200 mg/day may be administered. In comparative trials, amisulpride administered within this range (400 to 1200 mg/day) was as effective as haloperidol 5 to 40 mg/day, flupenthixol 25 mg/day and risperidone 8 mg/day in patients with acute exacerbations of schizophrenia with predominantly positive symptoms. Amisulpride was more effective than haloperidol but equally effective as risperidone in controlling negative symptoms. Amisulpride 400 to 800 mg/day was more effective than haloperidol, risperidone and flupenthixol in controlling affective symptoms in these patients. In randomised, double-blind trials involving patients with predominantly negative symptoms of schizophrenia, amisulpride 50 to 300 mg/day was more effective than placebo. Amisulpride is effective as maintenance therapy in patients with chronic schizophrenia. Long-term treatment with amisulpride was associated with improvements in quality of life and social functioning. Amisulpride is generally well tolerated. In well-controlled trials, the neurological tolerability profile (including ratings on extrapyramidal symptom scales) of amisulpride 400 to 1200 mg/day was superior to that of the conventional antipsychotics (haloperidol or flupenthixol), but was similar to that of the atypical antipsychotic risperidone. At low dosages of amisulpride (< or = 300 mg/day), the incidence of adverse events (including extrapyramidal symptoms) reported with amisulpride was similar to that with placebo. Conclusion: In comparative trials, amisulpride 400 to 1200 mg/day showed efficacy in reducing overall symptomatology and positive symptoms similar to that of conventional antipsychotics and newer atypical antipsychotics in patients with acute exacerbations of schizophrenia. Moreover, its effective alleviation of negative and affective symptoms, its lower association with extrapyramidal symptoms and loss of cognitive function than conventional antipsychotics and its long-term efficacy justifies consideration of the use of higher dosages of amisulpride in this group of patients. Consequently, the dosage of amisulpride that is recommended in patients with acute exacerbations of schizophrenia is 400 to 800 mg/day, although dosages < or = 1200 mg/day may be administered. Lower dosages of amisulpride (50 to 300 mg/day) should be considered for the management of patients with negative symptoms of schizophrenia. Amisulpride is a first-line treatment option in the management of schizophrenia in the acute phase and for the maintenance of treatment response.     

Pharmacogenetic studies of response to risperidone and other newer atypical antipsychotics

Risperidone and other newer atypical antipsychotics are becoming the mainstay for schizophrenia treatment. Recent studies suggest that the 5-hydroxytryptamine receptor 2A (5-HT2A) gene (HTR2A) T102C and G-1438A polymorphisms may influence treatment response of risperidone or olanzapine for schizophrenia's negative symptoms (e.g., blunted affect and social withdrawal). In addition, the HTR6 T267C polymorphism has been linked to risperidone response for positive symptoms (delusions and hallucinations). The dopamine D2 receptor (DRD2) Ser311Cys polymorphism may also play a role in determining risperidone efficacy for positive, negative and cognitive symptoms, the DRD2 Ins-A2/Del-A1 diplotype may predict better risperidone response, and the DRD3 Ser311Cys variant may affect general treatment response of several atypical agents. Although investigators have started to explore genetic effects on cognitions of schizophrenia patients receiving antipsychotics, future larger sized pharmacogenetic studies on both psychotic symptoms and cognitive functions are warranted.     

阿立哌唑与利培酮治疗精神分裂症对照研究

目的:探讨阿立哌唑治疗精神分裂症的疗效及不良反应。方法:以阿立哌唑与利培酮治疗精神分裂症各30例作对照研究,采用阳性症状与阴性症状量表(PANSS)、不良反应症状量表(TESS)评定疗效及不良反应。结果:两组RANSS总分在治疗后与治疗前比较有显著性差异(P<0.01),阿立哌唑组有效率93%,显效率83%,利培酮组有效率90%,显效率80%;两组间疗效无显著性差异(P>0.05),利培酮组副作用比阿立哌唑组多。结论:阿立哌唑治疗精神分裂症疗效确切,且安全性高。     

帕利哌酮与利司哌酮治疗精神分裂症近期疗效与安全性比较

目的比较帕利哌酮与利司哌酮治疗精神分裂症的近期疗效及安全性。方法 94例精神分裂症患者分为帕利哌酮组与利司哌酮组,每组47例。帕利哌酮组起始剂量3mg·d~(-1),每隔1～2wk增加剂量1次,增幅为每次3mg,剂量稳定在3～12mg·d~(-1);利司哌酮组起始剂量2m·d~(-1),每隔1～3d增加剂量1次,增幅为每次2mg,2wk内加至4～6mg·d~(-1),观察6wk。于基线及wk 2、4、6末,采用阳性和阴性症状量表(PANSS)评定疗效,采用副反应量表(TESS)评定不良反应。结果最终纳入分析的有91例,其中帕利哌酮组47例,利司哌酮组44例。治疗4、6 wk末2组PANSS总分、阳性症状分、阴性症状分和精神病理症状分均显著降低(P<0.05或P<0.01)。wk 6末帕利哌酮组治疗有效率为70%,利司哌酮组为66%,疗效无显著差异(P>0.05)。wk 2末2组间PANSS总分、阳性症状分和精神病理症状分有非常显著差异(P<0.01),阴性症状分无显著差异(P>0.05);wk 4、wk 6末2组间PANSS总分及各分项分均无显著差异(P>0.05)。帕利哌酮组和利司哌酮组不良发应发生率无显著差异(72%vs.80%,P>0.05),帕利哌酮组锥体外系反应发生显著少于利司哌酮组(P<0.01)。结论帕利哌酮治疗精神分裂症的疗效与利司哌酮相当,且起效较快,锥体外系反应发生较少,安全性较好。     

Long-acting risperidone: a review of its use in schizophrenia

Long-acting risperidone (Risperdal Consta) is a novel, intramuscular formulation of the atypical antipsychotic risperidone, which has shown efficacy in the treatment of patients with schizophrenia.Long-acting risperidone is pharmacokinetically equivalent to and causes less plasma drug concentration fluctuation than the oral formulation. This novel formulation is an aqueous suspension of microspheres comprising risperidone and a biodegradable copolymer. Significant release of risperidone from the microspheres begins 3 weeks after the first injection: thus, administration of another antipsychotic is necessary during this period only. Steady-state plasma concentrations are reached after the fourth injection. Elimination is complete 7-8 weeks after the last injection.Long-acting risperidone 25 or 50mg every 2 weeks demonstrated significantly greater antipsychotic efficacy than placebo and equivalent efficacy to oral risperidone 2-6 mg/day in two randomised, double-blind, double-dummy, 12-week trials of patients with schizophrenia. Additionally, in one of these trials, improvements in health-related quality of life (HRQOL) were superior with long-acting risperidone than placebo. Compared with baseline, improvements in the symptoms of schizophrenia in stable patients were significant with long-acting risperidone 25 or 50mg (12-month trial) and 25, 37.5 or 50mg (12-week trial) every 2 weeks, in two noncomparative, multicentre trials. Patient satisfaction with their medication and patient HRQOL mental health scores improved significantly in the 12-month trial.Long-acting risperidone is generally well tolerated, with a low incidence of injection site pain and an otherwise similar profile of adverse effects to the oral formulation. The overall incidence of extrapyramidal disorders in clinical trials was low (< or= 10%) with similar, yet minimal, changes in extrapyramidal symptom severity between patients treated with long-acting risperidone, oral risperidone or placebo. Tardive dyskinesia was reported in the 12-month trial, in 0.7% of patients. CONCLUSIONS: Long-acting risperidone is effective and generally well tolerated in patients with schizophrenia, including those patients with stable symptoms. Long-acting risperidone is the first atypical antipsychotic available in a formulation which offers a sustained, steady release of drug and is thus an attractive, new option in the treatment of patients with schizophrenia.     

Efficacy and safety of risperidone long-acting injectable in stable psychotic patients previously treated with oral risperidone

This subgroup analysis of symptomatically stable patients with schizophrenia or other psychotic disorders in the StoRMi trial determined the efficacy and tolerability of risperidone long-acting injectable in patients changed from oral risperidone monotherapy. Risperidone long-acting injectable was administered open-label (dosage 25/37.5/50 mg every 2 weeks for 6 months). In total, 568 patients (60% men, mean age 36-40 years) were included and grouped according to pre-trial oral risperidone dosage (56% < or =4 mg; 30% >4 to < or =6 mg; 14% >6 mg). Most patients (71-85% across groups) were diagnosed with schizophrenia. At endpoint, risperidone long-acting injectable dosages partly correlated with the previous oral risperidone dosage. Some patients previously on high dosages of oral risperidone responded well to lower risperidone long-acting injectable dosages. Efficacy significantly improved from baseline to endpoint in all groups; total Positive and Negative Syndrome Scale score improved by > or =20% in 39% of all patients. Clinical global impression symptoms, global assessment of function scores, and the SF-36 mental component summary score significantly improved in all groups. Hospitalizations were reduced by 74-80%. Extrapyramidal symptom rating scale scores were significantly better at endpoint (P< or =0.001). These results indicate that further improvement in symptom control can be seen after a change to risperidone long-acting injectable in clinically stable patients previously treated with oral risperidone.     

Risperidone-induced obsessive-compulsive symptoms: a series of six cases

Risperidone is a novel and atypical agent with a dual antagonistic effect on 5-HT and D receptors. Open-label reports and one controlled study suggest that risperidone addition is effective in patients with obsessive-compulsive disorder refractory to treatment with serotonin reuptake inhibitors. However, risperidone has also been implicated in the production or exacerbation of obsessive-compulsive symptoms. We report six cases (schizophrenia, five cases; psychotic depression, one case) in which risperidone was effective in the treatment of the psychotic symptoms but produced obsessive-compulsive symptoms (four cases) or caused exacerbation of previous obsessive-compulsive symptoms (two cases). In all but one case, obsessive-compulsive symptoms emerged shortly after initiation of risperidone treatment with a dose above 3 mg/day. The mechanisms and risk factors for risperidone and other atypical antipsychotics to induce or exacerbate obsessive-compulsive symptoms are as yet not clear. Risperidone-induced obsessive-compulsive symptoms appear to be dose-dependent and are probably produced by serotoninergic-dopaminergic imbalance. Close monitoring of the patients receiving risperidone, especially those vulnerable to the development of obsessive-compulsive symptoms, may be of value. Gradual escalation and low final dose may be helpful.(2) (2)     

阿立哌唑与利培酮治疗精神分裂症对照研究

目的:探讨阿立哌唑与利培酮治疗精神分裂症的疗效和不良反应。方法:应用阿立哌唑与利培酮分别治疗精神分裂症各34例,疗程8周。用阳性与阴性症状量表(PANSS)评定疗效,用治疗中出现的症状量表(TESS)评定药物不良反应。结果:两组PNSS总评分治疗前后差异有显著性。阿立哌唑组总有效率82.3%,利培酮组为82.3%,两者相同(P>0.05)。不良反应发生率:阿立哌唑组为19.82%,利培酮组为25.32%,阿立哌唑组低于利培酮组,差异有显著性(P<0.05)。结论:阿立哌唑与利培酮对精神分裂症有疗效好,且疗效相同。但不良反应少,是一种安全、有效的抗精神药。     

免费服用利培酮对首发精神分裂症病人干预的成本-效果分析

目的 探讨免费服用利培酮对首发精神分裂症病人的成本-效果。 方法 选取2014年10月至2015年5月上海市浦东某社区重性精神病规范化管理的首发精神分裂症病人100例,采用随机数字表法均分为干预组和对照组各50例。对照组给予常规门诊服务和自费购买利培酮;干预组除接受常规门诊服务外,还接受免费的利培酮和社区随访等服务;随访观察周期为1年。采用自制成本调查表、大体评定量表(GAS)对两组的成本-效果进行评价。 结果 干预前,干预组和对照组的GAS评分、病情情况差异无统计学意义。经1年干预后,两组的成本差异无统计学意义,干预组的GAS评分和病情控制率高于对照组。分别以GAS评分和控制率为干预效果进行成本-效果评价,发现干预组的平均成本-效果比均低于对照组;增量成本-效果(△C/△E)分别为30.89元和8.58元。     

Sildenafil adjunctive therapy to risperidone in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled trial

Rational

It has been suggested that phosphodiesterase 5 inhibitors such as sildenafil may be effective in the treatment of negative symptoms of schizophrenia.

Objective

This study was designed to investigate the effect of sildenafil added to risperidone as augmentation therapy in patients with chronic schizophrenia and prominent negative symptoms in a double-blind and randomized clinical trial.

Methods

Eligible participants in the study were 40 patients with chronic schizophrenia with ages ranging from 18 to 45?years. All patients were inpatients and were in the active phase of the illness and met DSM-IV-TR criteria for schizophrenia. Patients were allocated in a random fashion: 20 to risperidone (6?mg/day) plus sildenafil (75?mg/day) and 20 to risperidone (6?mg/day) plus placebo. The principal measure of outcome was Positive and Negative Syndrome Scale (PANSS).

Results

Although both protocols significantly decreased the score of the positive, negative, and general psychopathological symptoms over the trial period, the combination of risperidone and sildenafil showed a significant superiority over risperidone alone in decreasing negative symptoms and PANSS total scores over the 8-week trial (between-subjects factor; F?=?4.77, df?=?1; P?=?0.03; F?=?5.91, df?=?1, P?=?0.02 respectively).

Conclusion

Therapy with 75?mg/day of sildenafil was well tolerated, and no clinically important side effects were observed. The present study indicates sildenafil as a potential adjunctive treatment strategy for treatment of negative symptoms of schizophrenia. This trial is registered with the Iranian Clinical Trials Registry (IRCT1138901151556N11).     

帕潘立酮与利培酮用于精神分裂症的对比分析

目的探讨帕潘立酮与利培酮片治疗精神分裂症的效果和不良反应。方法60例精神分裂症患者随机分为观察组和对照组各30例,分别给予帕潘立酮与利培酮治疗,疗程8周。分别于治疗前和治疗1、2、4和8周采用阳性与阴性症状量表（PANSS）评定疗效;以治疗中出现的症状量表评定不良反应。结果治疗后两组PANSS计分均比治疗前显著下降（均P〈0．01）;观察组阴性症状计分在治疗4周与8周时明显比对照组更低（均P〈0．05）。观察组显效率（70％）明显高于对照组（47％）,两组有效率（90％与80％）差异无统计学意义（P〉0．05）。结论帕潘立酮是安全有效的抗精神病药物,对阴性症状的改善尤为显著。     

Switching from risperidone to olanzapine in a one-year,randomized, open-label effectiveness study of schizophrenia

ABSTRACT

Objective: Switching medications is common in the treatment of schizophrenia. This study examines the effectiveness of olanzapine therapy following a clinically warranted switch from risperidone during treatment of patients with schizophrenia.

Research design and methods: This post-hoc analysis used data from the risperidone arm of a randomized, open-label, 1-year study of patients with schizophrenia. Study protocol permitted antipsychotic switching when clinically warranted, and outcomes were assessed with standard psychiatric measures. Statistical analyses assessed changes from pre- to post-medication switch and endpoint comparisons between patients switched from risperidone to olanzapine and patients continued on risperidone.

Results: Most patients who switched from risperidone switched to olanzapine (43/60; 71.7%). Average duration of risperidone treatment prior to switching was 86 days (mean modal dose 4.0?mg/day). Most switchers (86%) completed the 1-year study on olanzapine (average duration 241 days; mean modal dose 12.0?mg/day). Following switch to olanzapine, patients experienced significant improvements on clinical (Brief Psychiatric Rating Scale) and social (Quality of Life Inventory) parameters, with similar proportions of patients achieving remission status at endpoint compared with risperidone patients not requiring medication switch (41.9 vs. 35.5%). Mean weight gain for switchers was approximately 0.4?kg while on risperidone (average treatment duration <?3 months) and 2.4?kg on olanzapine (average treatment duration approximately 8 months).

Conclusions: This study suggests that olanzapine is an effective treatment option for schizophrenia patients requiring a switch from risperidone. Given the small sample size and lack of a comparative group, one cannot determine if other medication options would have been as effective as the switch to olanzapine. Thus, further research is warranted.     

Paliperidone: the evidence of its therapeutic value in schizophrenia

Introduction:

Paliperidone, the 9-hydroxy metabolite of risperidone, is a second-generation antipsychotic that was recently approved for the treatment of schizophrenia. It is marketed as an improvement over risperidone, but is likely to be considerably more costly when risperidone is no longer protected by patent.

Aims:

To review the evidence for the clinical impact of paliperidone in the treatment of patients with schizophrenia, particularly in contrast to risperidone.

Evidence review:

Paliperidone is primarily metabolized and excreted renally, and thus may be of particular utility for patients with hepatic impairment. There is clear evidence that paliperidone is more efficacious than placebo in reducing the positive and negative symptoms of schizophrenia. In patients with schizophrenia, paliperidone has been shown to stabilize acute psychotic symptoms. There is some evidence that it can prevent relapse in stabilized patients. Studies on the cost effectiveness of paliperidone are needed. Most importantly, there are no trials comparing paliperidone directly with other second-generation antipsychotics.

Place in therapy:

Until direct efficacy and cost effectiveness comparisons are made with risperidone, it is difficult to justify paliperidone use over risperidone. It will become even harder to justify when risperidone becomes available as a less expensive generic medication.     

Supersensitivity psychosis in schizophrenic patients after sudden clozapine withdrawal

In two patients with chronic schizophrenia, who were on clozapine medication for more than 6 months, a sudden withdrawal of the drug resulted in a very pronounced deterioration of the psychosis within 24–48 h. The most prominent symptoms were auditory hallucinations and persecutory ideas and one patient tried to commit suicide. These observations are interpreted as supersensitivity psychoses induced by the very effective clozapine treatment.     

帕利哌酮与利培酮治疗首发精神分裂症的临床疗效与安全性Δ

目的:比较帕利哌酮与利培酮治疗首发精神分裂症的临床疗效及安全性。方法:92例首发精神分裂症患者分为帕利哌酮(3～12 mg.d-1)组和利培酮(4～6 mg.d-1)组各46例,疗程为8周。于基线及服药2、4、6、8周末,采用阳性和阴性症状量表(PANSS)评定疗效、副反应量表(TESS)评定不良反应。结果:最终入组的患者为89例,其中帕利哌酮组45例,利培酮组44例,治疗4、6、8周末2组的PANSS总分、阳性症状评分、阴性症状评分和精神病理评分均显著降低(P<0.01)。治疗2周末,2组间PANSS总分、阳性症状评分和一般病理症状评分比较,有显著差异(P<0.01),阴性症状评分比较无显著差异(P>0.05)。治疗8周末帕利哌酮组PANSS总分减分率为(68.3±11.7)%,利培酮组为(67.8±12.1)%;帕利哌酮组有效率为71.1%,利培酮组为68.2%,2组疗效比较无显著差异(P>0.05)。帕利哌酮组锥体外系反应发生少于利培酮组(P<0.05)。结论:帕利哌酮治疗首发精神分裂症疗效与利培酮相当,且起效快、锥体外系反应少、安全性较好。